Treatment of Perforated Appendicitis in Children: Focus on Phlegmon

Calvert, Catherine; Tracy, Sarah A.; Zhou, Jing; Lebowitz, Mollie Blazar; Dennett, Kate V.; Chen, Catherine

doi:10.1177/000313481408000332

Cited by 5 publications

(14 citation statements)

References 4 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The general characteristics of the included studies are shown in Table 1. Designs of the studies were one pilot randomized controlled trial [6], two non-randomized prospective studies [5,18], and 11 retrospective studies [12,13,[15][16][17][18][19][20][21][22][23]. These 14 studies included 1355 children, of which 333 were included in the EA group with a median [range] of 19 patients per study and 1022 in the NOT group with a median [range] of 32 patients per study.…”

Section: Included Studiesmentioning

confidence: 99%

“…The interrater reliability for judging the subdomains of the ROBINS-I and Risk of Bias tool 2.0 was substantial (76% agreement). All studies were assessed as moderate to serious risk of bias on the primary outcome (overall complication rate) according to the ROBINS-I tool and some concerns were expressed according to the Risk of Bias tool 2.0 for the study by St Peter (Table 2) [5,6,[12][13][14][15][16][17][18][19][20][21][22][23]. Bias due to confounding was serious in most cohort studies and moderate in only 4 of them [5,13,18,21].…”

Section: Quality Of the Studiesmentioning

confidence: 99%

“…Risk of bias in selection of participants was low in eight [5, 12-14, 18, 19, 21, 22], moderate in two [16,20] and serious in two studies [17,23].…”

Section: Quality Of the Studiesmentioning

confidence: 99%

“…Evidence and conclusions of the original studies were rated as level 2b in 3 studies [5,6,18] and level 4 in 11 studies [12,13,[15][16][17][18][19][20][21][22][23].…”

Section: Quality Of the Studiesmentioning

confidence: 99%

“…2.) The overall complication rate was significantly lower for initial NOT compared to EA (RR 0.37 [95%CI 0.21-0.64], p = 0.0004) [5,6,[12][13][14][15][16][17][18][19][20][21][22][23]. Both the sensitivity analysis including only studies published after 2000 and the sensitivity analysis including only studies that further specified their definition of appendiceal abscess and/ or mass (and thus not only mentioned the terms 'appendiceal mass/phlegmon' or 'appendiceal abscess'), showed similar results [5, 6, 12, 13, 15-18, 20, 21].…”

Section: Primary Outcome: Overall Complication Ratementioning

confidence: 99%

See 4 more Smart Citations

Management of appendiceal mass and abscess in children; early appendectomy or initial non-operative treatment? A systematic review and meta-analysis

et al. 2020

View full text Add to dashboard Cite

Background Appendiceal mass and abscess and its treatment are associated with significant morbidity and high costs. Still, the optimal treatment strategy is the point of debate. Therefore, this systematic review and meta-analysis aimed to compare overall complications between initial non-operative treatment (NOT) and early appendectomy (EA) in children with appendiceal mass and/or abscess. Methods Pubmed and Embase were searched. Only randomized controlled trials and prospective or historical cohort studies that compared NOT with EA in children with appendiceal mass or abscess in terms of complications were eligible for inclusion. Risk of bias was assessed. Primary outcome was the overall complication rate. Secondary, length of stay and readmission rate were investigated. A meta-analysis of overall complications associated with both treatment strategies was performed. Results 14 of 7083 screened studies were selected, including 1022 children in the NOT group and 333 in the EA group. Duration of follow-up ranged between four weeks and 12 years. Risk of bias was moderate in four and serious in 10 studies. NOT was associated with a lower overall complication rate (risk ratio (RR) 0.37 [95% confidence interval (CI) 0.21–0.65]). However, NOT led to increased length of stay (mean difference varied between 0.2 and 8.4 days) and higher readmission rate (RR 1.75 [95%CI 0.79–3.89]), although not significantly. Interval appendectomy after NOT was performed as a routine procedure in all but one study. This study found a recurrence rate of 34% in a group of 38 patients during a follow-up period of 3.4 ± 1.7 years. Conclusion NOT may reduce the overall complication rate compared to EA, but the evidence is very uncertain. As evidence is scarce, and of low level, and heterogeneity between studies is substantial, the results should be interpreted with caution. Large prospective studies are needed to determine the optimal treatment strategy for children with appendiceal mass and/or abscess.

show abstract

Section: Included Studiesmentioning

confidence: 99%

Section: Quality Of the Studiesmentioning

confidence: 99%

“…Risk of bias in selection of participants was low in eight [5, 12-14, 18, 19, 21, 22], moderate in two [16,20] and serious in two studies [17,23].…”

Section: Quality Of the Studiesmentioning

confidence: 99%

“…Evidence and conclusions of the original studies were rated as level 2b in 3 studies [5,6,18] and level 4 in 11 studies [12,13,[15][16][17][18][19][20][21][22][23].…”

Section: Quality Of the Studiesmentioning

confidence: 99%

Section: Primary Outcome: Overall Complication Ratementioning

confidence: 99%

See 3 more Smart Citations

Management of appendiceal mass and abscess in children; early appendectomy or initial non-operative treatment? A systematic review and meta-analysis

et al. 2020

View full text Add to dashboard Cite

show abstract

Immediate surgery or conservative treatment for complicated acute appendicitis in children? A meta-analysis

Vaos

Dimopoulou

Gkioka

et al. 2019

Journal of Pediatric Surgery

View full text Add to dashboard Cite

Effect of instant surgery compared with traditional management on paediatric complicated acute appendicitis post‐surgery wound: A meta‐analysis

Cao

Geng

Zhang

et al. 2023

International Wound Journal

View full text Add to dashboard Cite

A meta‐analysis study to assess the influence of instant surgery (IS) compared with conservative therapy (CT) on paediatric complicated acute appendicitis (CAA) post‐surgery wounds. A comprehensive literature examination until January 2023 was implemented, and 2098 linked studies were appraised. The picked studies contained 66 674 subjects with paediatric CAA post‐surgery wounds in the picked studies' baseline; 64 643 of them were using IS, and 2031 were using CT. The odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to calculate the consequence of the IS compared with the CT on paediatric CAA post‐surgery wounds using the dichotomous and continuous styles and a fixed or random model. The IS had a significantly higher wound infection (OR, 4.97; 95% CI, 2.35–10.54, P < .001) with moderate heterogeneity (I2 = 57%) compared with the CT in a paediatric CAA post‐surgery wound. However, no significant difference was found between IS and CT in total antibiotic duration (MD, −5.34; 95% CI,−12.67 to −1.98, P = .15) with high heterogeneity (I2 = 95%) in paediatric CAA post‐surgery wounds. The IS had a significantly higher wound infection; however, no significant difference was found in total antibiotic duration compared with the CT in paediatric CAA post‐surgery wounds. Although precautions should be taken when commerce with the consequences because most of the studies picked for this meta‐analysis had low sample sizes.

show abstract

Treatment of Perforated Appendicitis in Children: Focus on Phlegmon

Cited by 5 publications

References 4 publications

Management of appendiceal mass and abscess in children; early appendectomy or initial non-operative treatment? A systematic review and meta-analysis

Management of appendiceal mass and abscess in children; early appendectomy or initial non-operative treatment? A systematic review and meta-analysis

Immediate surgery or conservative treatment for complicated acute appendicitis in children? A meta-analysis

Effect of instant surgery compared with traditional management on paediatric complicated acute appendicitis post‐surgery wound: A meta‐analysis

Contact Info

Product

Resources

About